Survey of Nurses 2013

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1 Survey of Nurses 2013

2 Survey of Nurses Report Summary Since 2004, the Michigan Center for Nursing has conducted an annual survey of Michigan nurses in conjunction with the licensure renewal process for purposes of workforce analysis and informing stakeholder discussions. To see the full 2013 Nursing Survey report go to 54,977 28, ,077 licensed RNs active & in direct patient care 84,100 Estimated number of active RNs and LPNs, by Age, 2004 and ,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 < Changes in employment in the last three years, active nurses 10% 8% 6% 4% 2% 0% Changed from: 1% 2% 2% 5% RN specialty care primary care position primary care specialty care position LPN outpatient inpatient position inpatient outpatient position The estimated number of nurses were calculated using the estimated number of active nurses in % 3% 1% 3% 7,397 2,719 inactive active RNs 81% active LPNs 73% active & in direct patient care 27,396 licensed LPNs 17,280 Active means working full- or part-time in nursing or a related field. RN 2013 RN 2004 LPN 2013 LPN 2004 Estimates for 2004 are based on the total number of RNs with a Michigan mailing address. Estimates for 2004 do not include nurses whose employment status is unknown. Estimates for 2013 are based on the total number of active RNs licensed in Michigan. Active RNs and LPNs planning to continue practicing nursing for the next 1 to 10 years 50% 40% 30% 20% 10% 0% 40% of active RNs are aged 55 or over 42% RNs 47% of active LPNs are aged 55 or over 45% LPNs Interdisciplinary patient care teams Core activities of an interdisciplinary team: Discussion of team members roles and responsibilities Clinical discussions or huddles with the patient care team Patient rounds with other members of the patient care team Team meetings with patients and their families Development of shared goals reflective of patient priorities and supported by all team members Virtual communication with other team members through an electronic health record, , or text message Evaluation of team processes and patient health outcomes About 68% of RNs & 55% of LPNs report they participate on an interdisciplinary patient care team. Only 14% of RNs & 6% of LPNs report participating in all core activities of an interdisciplinary patient care team. The core activities of an interdisciplinary team are described by the Institute of Medicine in Core Principles & Values of Effective Team-based Health Care, a discussion paper released in 2012.

3 Table of Contents Introduction... 3 Methodology... 3 Number of Nurses... 3 Ratio of Nurses to Population... 5 Age of Nurses... 5 Length of Time Remaining in Nursing... 6 Changes in Employment... 6 Work Setting... 6 Practice Area... 7 Interdisciplinary Patient Care Teams... 8 Specialty Certification... 9 Education... 9 Racial/Ethnic Background and Gender Appendix A: Survey Instrument and RN Response Frequencies Appendix B: Survey Instrument and LPN Response Frequencies Prepared by Public Sector Consultants Inc. Lansing, MI

4 Introduction One of the goals of the Michigan Center for Nursing is to establish a central resource for nursing workforce data collection and analysis. The Michigan Center for Nursing conducts an annual survey of nurses licensed in Michigan to collect data on their employment status, geographic distribution, age, plans to continue practicing, work setting, practice area, specialty certification, education, gender, and racial/ethnic background. In 2013, questions regarding changes in employment were revised to examine the movement of nurses between inpatient and outpatient positions and primary care and specialty positions. Questions were added in 2013 to learn nurses perceptions of participation on an interdisciplinary patient care team and the role they serve on a team, and how many advanced practice register nurses hold a Drug Enforcement Agency (DEA) and/or National Provider Identifier (NPI) number (asked online only). This report presents the survey findings for 2013 and a description of the survey methodology. Methodology The Michigan Center for Nursing contracted with Public Sector Consultants Inc. (PSC) for development, implementation, and analysis of the survey of nurses. A single instrument for both RNs and LPNs was designed in collaboration with the Michigan Center for Nursing Advisory Board. (The survey instrument and response frequencies for RNs and LPNs are included in the appendices of this report, along with data from previous surveys as a reference.) The samples for these surveys were drawn from the Michigan licensure files maintained by the Michigan Department of Licensing and Regulatory Affairs. All nurses are required to renew their license every two years. The universe of nurses is divided into two cohorts of roughly equal size depending on the year in which each nurse was first licensed. The surveys were mailed to all nurses renewing their license in 2013 along with their license renewal notice. A total of 80,242 nurses (67,780 RNs and 12,462 LPNs) renewed their license. Nurses could either return the paper version of the survey to PSC or complete the survey online when they renewed their license. The large number of paper and Webbased surveys collected permits a robust analysis. Combining the responses from the paper version with the results from the Web survey resulted in a total of 18,657 completed RN surveys, yielding a margin of error of ±0.7 percent with 95 percent confidence; 1 and 1 For example, if the answer to a survey question is 60 percent Yes, the margin of error and confidence level mean that if this question were asked 100 times, in 95 occurrences the 2,894 completed LPN surveys, yielding a margin of error of ±1.7 percent with 95 percent confidence. These totals include fully and partially completed surveys (that is, those with information missing for one or more variables); thus the sample size for individual variables will differ and the margin of error may change slightly depending upon the amount of data for that particular variable. Previous years of survey data show a difference between the two cohorts of nurses in age distribution. The cohort of nurses who renewed their licenses in 2005, 2007, and 2009 was slightly older than the cohort who renewed their licenses in 2004, 2006, and When looking at trends since the first survey in 2004, survey responses that may be affected by age should be compared only to responses received from the same license renewal cohort in a previous survey. For the past few years, the age distribution within each of the two cohorts has been comparable; responses to questions that may be affected by age, such as plans to continue practicing nursing, can be compared for years 2010, 2011 and Data for the cohort of nurses surveyed in 2013 once again show a slightly older population than those who renewed their license in Therefore, survey responses in 2013 that are affected by age, should only be compared to those who renewed their license within the same license renewal cohort (i.e., 2005, 2007, 2009, and 2011). The large number of responses received each year and the sampling design assure that the survey findings are applicable to the entire population of nurses licensed in Michigan. If differences between survey findings from one year to another are significant (i.e., outside of the margin of error), they are noted in the text. 166, 473 licensed nurses (as of January 1, 2013) 132,790 are active (work full- or part-time in nursing or a related field) Number of Nurses The total number of nurses licensed by the State of Michigan is 166,473 (as of January 1, 2013). Of these, 139,077 are registered nurses (RNs) and 27,396 are licensed practical nurses (LPNs). Since 2012, the total number of answer of the entire universe of respondents would be between 59.3 percent and 60.7 percent (i.e., the ± 0.7 percent margin of error). In the other 5 occurrences, the true answer from the universe would be either below or above this range (confidence interval). 4 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

5 licensed nurses has increased by 1,815. The number of licensed RNs increased by 2,307 (2 percent), while the number of licenses for LPNs decreased by 492 (2 percent) during the same period. In 2013, about 81 percent of licensed RNs report that they are active in nursing working in nursing or a related area full- or part-time 2 (see Exhibit 1). Seventythree percent of LPNs are working in nursing or a related area. The percentage of licensed RNs and LPNs who are active in nursing has decreased significantly since 2004 when 87 percent of RNs and 82 percent of LPNs were active in nursing. The percentage of nurses reporting they are retired with no plans to return to work is about 8 percent for both licensed RNs and LPNs. 2 Throughout this report, the term active is used to refer to nurses who are working either full-time or part-time in nursing or a related area. Active does not include about 3 percent of licensed RNs and 6 percent of LPNs who are unemployed and seeking nursing work and could be considered part of the available nursing workforce. Some nurses who are active in nursing are not working in Michigan, even though they hold a Michigan license. And some nurses working in positions in related areas, such as nursing education or administration, do not provide direct care services to patients. The following estimates are based on survey findings for An estimated 103,317 RNs (about 92 percent of active RNs) are working in nursing or a related area in Michigan. An estimated 84,100 RNs (81 percent of the active registered nurses working in Michigan) provide direct patient care services in their main nursing position. An estimated 19,179 LPNs (approximately 96 percent of active LPNs) are working in nursing or a related area in Michigan. An estimated 18,019 LPNs (90 percent of the active LPNs working in Michigan) provide direct patient care services in their main nursing position. EXHIBIT 1. Employment Status of RNs and LPNs in Michigan, 2013 RNs LPNs % Number* % Number* Total number of nurses licensed by Michigan 139,077 27,396 Total active nurses employed in nursing or related area 81.1% 112, % 19,999 Not employed, and seeking employment in nursing or related area 2.6 3, ,726 Employed, but not in nursing 2.5 3, ,342 Not employed, and seeking employment outside nursing Temporarily not working and not looking for a job 5.2 7, ,055 Retired with no plans to return to work , ,192 Active nurses employed in Michigan 103,317 19,179 (91.6 percent of active RNs, 95.9 percent of active LPNs) Active nurses providing direct care services in Michigan (81.4 percent of active RNs employed in MI, 90.1 percent of active LPNs employed in MI) 84,100 18,019 SOURCE: Michigan Center for Nursing Survey of Nurses *NOTE: The number of nurses licensed by Michigan is from the Michigan licensure files maintained by the Michigan Department of Licensing and Regulatory Affairs as of January 1, All other numbers are estimated based on data from the Michigan Center for Nursing Survey of Nurses Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

6 Analysis of data in this report focuses on active nurses those who are working full- or part-time in nursing or a related area. In depth analysis of the data for these active nurses shows the following distribution between full- and part-time status: About 72 percent of active RNs are employed full-time (35 or more hours per week). This percentage has not changed significantly since About 67 percent of active LPNs are employed full-time. This also is relatively unchanged since Ratio of Nurses to Population Based on the employment location reported by nurses, the estimated ratio of active nurses to population in Michigan is 1,344 per 100,000.3 This nurse-to-population ratio estimate includes both LPNs and RNs who are employed in nursing full-time or part-time in Michigan. The estimated ratio of active registered nurses to population in Michigan is 1,141 for every 100,000 people, compared to 1,147 RNs for every 100,000 people in The ratio of active licensed practical nurses to population is approximately 202 LPNs per 100,000 people, compared to 214 LPNs per 100,000 people in Age of Nurses For several years the proportion of active licensed nurses nearing retirement had increased for both RNs and LPNs in Michigan. In 2012, the data showed the first drop in the percentage of active nurses who report that they are aged 55 and older, while the proportion of nurses who are under age 35 increased slightly. In 2013, however, the percentage of active nurses who report being age 55 or older increased once more. About 40 percent of active registered nurses in this license renewal cohort reported that they are aged 55 or older (see Exhibit 2), compared to 34 percent in 2012 and 37 percent in About 47 percent of active licensed practical nurses in this license renewal cohort are aged 55 or older, compared to 41 percent in 2012 and 44 percent in About 16 percent of active RNs report that they are under age 35, compared to 18 percent in 2012 and 15 percent in Nurse-to-population ratios for 2013 are calculated using the employment location reported by nurses and the U.S. Census Bureau annual population estimates for Michigan for Prior to 2004, licensure surveys used the mailing address of licensed nurses to estimate the number of nurses active in Michigan and nurse-to-population ratios. Using this methodology, the nurse-topopulation ratio for was 1,079 nurses per 100,000 people. 32.8% EXHIBIT 2. Proportion of Active RNs and LPNs, by Age 7.3% 2% 27.6% 13.6% Active RNs 16.6% Age < SOURCE: Michigan Center for Nursing Survey of Nurses NOTE: Percentages may add to more than 100 due to rounding. 36.2% 11.1% 1.8% 11.5% 24.4% Active LPNs 15.2% Exhibit 3 demonstrates the shift in the age distribution of nurses surveyed in 2004 compared to EXHIBIT 3. Distribution of Active Registered Nurse and Licensed Practical Nurse Populations in Michigan, by Age (2004 and 2013) 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 < RN 2013 RN SOURCE: Michigan Center for Nursing Survey of Nurses LPN 2013 LPN Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

7 Length of Time Remaining in Nursing In 2012, survey data showed a change in nurses plans to continue practicing that paralleled the slight shift in the age distribution of nurses to a younger demographic. However, in 2013, the percentage of RNs planning to work for only one to ten more years shifted back, similar to data within the same cohort in 2011 (42 percent and 41 percent respectively). The percentage of active LPNs who say they plan to practice for only one to ten Plans to practice for up to ten more years: more years followed a similar pattern. It is not just the nurses nearing retirement age who are planning to stop practicing nursing in the near future. As shown in Exhibit 4, nearly 42 percent of all active RNs say they plan to practice nursing for only one to ten more years; the data on the age of nurses show that 40 percent are aged 55 or older. Among active LPNs, about 45 percent say they plan to practice nursing for only one to ten more years, a similar percentage (47 percent) report they are aged 55 or older. 14.8% 9.5% 14.0% 3.8% 16.1% Active RNs EXHIBIT 4. Plans to Practice Nursing for Active RNs and LPNs, % 20.8% Length of time remaining in nursing practice 1 5 years 6 10 years years years years More than 30 years Don t know 10.3% 13.0% 11.7% 6.9% 13.6% 24.8% Active LPNs 19.8% Changes in Employment In 2013, survey questions regarding changes in the employment of nurses were revised from looking at changes in nursing positions to a different organization or changes within the same organization to examining changes in employment between inpatient and outpatient positions and primary care and specialty positions. About 5 percent of RNs (an estimated 5,640 4 ) changed from an inpatient position to an outpatient position, while about 2 percent (2,256) did the opposite. Similar migration occurred with LPNs about 3 percent of LPNs (an estimated 600) changed from an inpatient position to an outpatient position, while 1 42% RNs 45% LPNs Primary care to specialty care: 2% RNs / 3% LPNs percent (200) did the opposite. About 2 percent of RNs (an estimated 2,256) changed from a primary care position (i.e., family practice, general medicine, internal medicine, or general pediatrics) to a specialty care position, while 1 percent (1,128) did the opposite. Similarly, almost 3 Specialty care to primary care: 1% RNs / 1 % LPNs percent of LPNs (an estimated 600) changed from a primary care position to a specialty care position, while 1 percent (200) did the opposite. Almost 21 percent of both RNs and LPNs said they made some other employment change within the past three years. Work Setting In 2013, about 70 percent of active registered nurses are employed in either a hospital inpatient or outpatient setting (see Exhibit 5), which is the same percentage as in In contrast, only about 20 percent of active LPNs are employed in a hospital setting. About 39 percent of LPNs are employed in a nursing home or long-term care facility, compared to 43 percent in 2012 and 45 percent in SOURCE: Michigan Center for Nursing Survey of Nurses The estimates for the number of nurses who made a change in employment in the last three years were calculated using the estimated number of active nurses. Since survey respondents were asked to mark all that apply, a nurse may be counted in more than one estimate. 7 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

8 EXHIBIT 5. Employment Setting of Active RNs and LPNs, 2013 Employment Settings RNs LPNs Hospital inpatient 53.2% 13.0% Hospital outpatient Home health care Nursing home/long-term care facility Physician s office Nursing education Non-hospital outpatient Public/community health Hospice Insurance company/health plan Federally qualified health center Elementary or secondary school health Nurse managed clinic Traveling/staffing agency Correctional system College health center Retail clinic Other None (not active in nursing) SOURCE: Michigan Center for Nursing Survey of Nurses NOTE: Nurses were asked to indicate all of their current employment settings, so the sum of the percentages will be more than 100 percent. Federally qualified health center, correctional system, nurse managed clinic, and retail clinic were added as settings in the 2011 survey. Also in 2011, school health was separated into two setting options: elementary or secondary school health and college health center. Practice Area About 81 percent of active RNs and 90 percent of active LPNs report that their main nursing position involves providing direct care services to patients/ families. These nurses were asked to identify their main practice area from a list of areas given (see Exhibit 6). The practice areas that RNs identify most often are primary care (i.e., general/family practice, internal medicine, and pediatrics) and critical care (at 9 percent each). LPNs who provide direct care identified their main practice area as geriatrics/elderly care (41 percent). In previous surveys, the highest percentage of RNs identified med-surg as their main practice area. In 2011, the response option was changed from medsurg to medical-surgical. The percentage of RNs citing medical-surgical in 2012 was 3 percent and in 2013 it has dropped to less than 2 percent, compared to 15 percent in These differences may be due to confusion regarding the response option titled medical-surgical. EXHIBIT 6. Main Practice Area of Active RNs and LPNs Who Provide Direct Patient Care, 2013 Main Practice Area RNs LPNs Critical care 9.0% 0.5% Peri-operative Geriatrics/elderly care Cardiology/ cardiac care Emergency/urgent care Obstetrics Pediatrics Case Management Psychiatric/mental health Oncology Hospice/palliative care Rehabilitation Neonatal Medical-Surgical General/Family Practice Patient education Endoscopy/diagnostic testing Women s health Anesthesia Dialysis/hemodialysis Internal Medicine Other SOURCE: Michigan Center for Nursing Survey of Nurses Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

9 Interdisciplinary Patient Care Teams The Institute of Medicine (IOM) defines an interdisciplinary team (also referred to as inter-professional team by other sources) as one that includes at least two different types of health providers who work collaboratively with patients and their care givers to the extent preferred by each patient to accomplish shared goals within and across settings to achieve coordinated, high-quality care. 5 In 2013, questions were added to the nurse survey to obtain information on how many nurses are members of an interdisciplinary patient care team and to determine their role on the team. About 68 percent of RNs and 55 percent of LPNs reported being a member of an interdisciplinary patient care team. Core activities of an interdisciplinary team, based on the IOM core principles and description of team processes, 6 include: discussing the roles and responsibilities of each team member; conducting huddles or clinical discussions with the team; conducting patient rounds with other members of the team; holding team meetings with patients and their families; developing shared goals that are reflective of the patient s priorities and supported by all team members; communicating with other team members virtually using text, , and/ or electronic health records; and continuously evaluating team processes and patient outcomes. For those nurses who reported participating in core activities of an interdisciplinary patient care team, the majority said they participate in clinical discussions or huddles with the patient care team (66 percent of RNs) and the development of shared goals reflective of patient priorities and supported by all team members (60 percent of RNs and 51 percent of LPNs). (See Exhibit 7.) Only 14 percent of RNs and 6 percent of LPNs report participating in all core activities of an interdisciplinary patient care team. PSC conducted a crosstab analysis of survey data to look at how many nurses within each work setting and main practice area said they are a member of an interdisciplinary patient Only 14% of RNs and 6% of LPNs report participating in all core activities of an interdisciplinary patient care team. EXHIBIT 7. Percentage of Nurses Participating in Core Activities of an Interdisciplinary Team, 2013 Activities of an interdisciplinary team: RNs LPNs Clinical discussions or huddles with the patient care team 66% 48% Development of shared goals reflective of patient priorities and supported by all team members Discussion of team members roles and responsibilities Evaluation of team processes and patient health outcomes Virtual communication with other team members through an electronic health record, , or text message Patient rounds with other members of the patient care team Team meetings with patients and their families Participation in all interdisciplinary team core activities 14 6 SOURCE: Michigan Center for Nursing Survey of Nurses 2013 and Core Principles & Values of Effective Team-based Health Care, Institute of Medicine, NOTE: Percentages will not equal 100 percent because respondents were asked to Mark all that apply. 5 P. Mitchell, Core Principles & Values of Effective Team-based Health Care. Discussion Paper, Institute of Medicine, Washington, D.C., Available: (accessed ). 6 Ibid. 9 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

10 care team in their current position. Registered nurses who report working in a hospice, home health care, or federally qualified health center setting are more likely to be a member of an interdisciplinary patient care team than RNs working in other settings (see Exhibit 8). RNs who identify their main practice area as hospice, psychiatric/mental health, case management, or rehabilitation reported being a member of an interdisciplinary patient care team. When PSC analyzed data for LPNs by working settings and practice area, the samples were too small to draw conclusions about participation in teams. Exhibit 8. Work Settings and Practice Areas with the Highest Percentages of RNs Reporting Participation in an Interdisciplinary Patient Care Team Work Settings Main Practice Areas Hospice 88% Hospice/palliative care 94% Home health care 81 Psychiatric/mental health 89 Federal Qualified Health Center 79 Case management 88 Nurse managed clinic 78 Rehabilitation 88 Nursing home/long-term care facility 78 Dialysis/hemodialysis 85 Hospital inpatient 72 Critical care 81 Traveling/staffing agency 71 Geriatrics/elderly care 79 Correctional system 71 Oncology 76 Hospital outpatient 68 Neonatal 76 Non-hospital outpatient 67 Internal Medicine 75 Physician s office 59 Medical-Surgical 74 Cardiology/cardiac care 74 Pediatrics 73 Specialty Certification In 2011, a question was added to the survey that asked registered nurses to provide information on any specialty certification they may hold, and on average, how many hours per week they provide direct patient care as an advanced practice nurse. In 2013, additional questions were added to learn more about this population of nurses and find out how many hold a DEA and/or NPI number. A Drug Enforcement Agency, or DEA number, authorizes the holder to prescribe medications to patients. A National Provider Identifier, or NPI number, allows the holder to submit claims for reimbursement for services they provide to patients. In 2013, almost 4 percent of RNs report holding a specialty certification as a nurse practitioner; 1 percent as a nurse anesthetist; and less than one-tenth of a percent as a nurse midwife. Of those registered nurses who hold specialty certification, about 55 percent provide direct patient care as an advanced practice registered nurse (APRN) for more than 35 hours per week (i.e., full-time). About 3 percent of APRNs are practicing, but with no time in direct patient care; about 6 percent are not currently practicing as an APRN. The new questions regarding how many advanced practice registered nurses hold a DEA and/or NPI number were added only to the online survey because of space limitations on the hard copy survey. Of the 526 active APRNs responding to the online survey, 53 percent said they currently have a DEA number, and about 79 percent of the 526 active APRNs responding to the survey online hold an NPI number. Education All nurses responding to the survey were asked to indicate their level of education (all degrees completed). Nurses may hold more than one nursing degree, so percentages total more than 100. About 42 percent of active RNs have an associate s degree in nursing and 17 percent have an RN diploma in nursing. About 44 percent hold a bachelor s degree in nursing. About 9 percent of active RNs hold a master s degree in nursing and almost 5 percent hold a master s degree in another field. Less than 1 percent of registered nurses hold a doctorate in nursing. Among those with a doctorate: 57 percent have a Doctor of Philosophy (PhD), compared to 71 percent in 2012 and 67 percent in 2011 About 39 percent have a Doctor of Nursing Practice (DNP), compared to 24 percent in 2012 and 27 percent in Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

11 About 2 percent have a Doctor of Nursing (ND), similar to previous years of survey data Almost 1 percent have a Doctor of Nursing Science (DNSc), compared to 4 percent in 2012 and 3 percent in percent of active LPNs have an LPN diploma or an LPN certificate of nursing. Approximately 4 percent of active RNs also hold an LPN diploma or an LPN certificate of nursing. About 8 percent of both RNs and LPNs report they hold some other degree. Beginning in 2009, nurses were asked whether they are currently enrolled in a bachelor s, master s, or doctorate degree program. About 7 percent of RNs and 2 percent of LPNs responding to the survey in 2013 are enrolled in a program to obtain a Bachelor of Science in Nursing (BSN) degree. Almost 3 percent of RNs are enrolled in a program to obtain a Master of Science in Nursing (MSN) degree. More than half (52 percent) of the nurses enrolled in an MSN degree program are enrolled in a program designed to prepare them for specialty certification as a nurse practitioner. Less than 1 percent of RNs are currently enrolled in a program to obtain a Doctor of Nursing Practice (DNP) or Doctor of Philosophy in Nursing (PhD). Racial/Ethnic Background and Gender Data on racial/ethnic and gender characteristics of the nursing population in Michigan show that: 6 percent of active RNs and 5 percent of active LPNs are male. About 88 percent of active RNs are white, 6 percent are African American, 3 percent are Asian, 1 percent are American Indian/Alaskan Native, and less than 1 percent are Middle Eastern or Pacific Islander. 80 percent of active LPNs are white, 15 percent are African American, 2 percent are Asian, 1 percent are American Indian/Alaskan Native, and less than 1 percent are Middle Eastern or Pacific Islander. 1 percent of active RNs and 2 percent of active LPNs are Spanish/ Hispanic/Latino. More than half (52%) of the nurses enrolled in an MSN degree program are enrolled in a program designed to prepare them for specialty certification as a nurse practitioner. 11 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

12 Appendix A: Survey Instrument and RN Response Frequencies ,8,9 For 2013 survey results, N=18,657 This information is being collected by the Michigan Center for Nursing to describe the supply of and demand for nurses in Michigan. Data from this survey will be used to inform state and local decision making regarding the recruitment, education, and employment of nurses in Michigan. The information you provide will be confidential; the identity of individual respondents will not be shared with anyone. Completion of the questions below is voluntary and does not affect your license. However, this information is important and your participation is encouraged and truly appreciated. Please complete the survey and return it with your renewal application in the envelope provided. If you are both an LPN and an RN, complete and return only one survey. If you renew your license via the Internet, you will have the opportunity to complete this survey online. Go to to view survey results and to sign up to receive Michigan Center for Nursing News & Updates electronically. 1. Are you a licensed practical nurse (LPN), a registered nurse (RN), or both? (Mark one.) If you are both an LPN and an RN, complete and return only one survey RN only 96.4% 95.8% 96.6% 96.4% 96.9% 96.8% 96.9% 97.5% 97.7% Both LPN and RN NOTE: This question was not asked on the 2004 survey. 2. Do you hold a Michigan specialty certification as a.. Active RNs Only Nurse Anesthetist 1.6% 1.1% 1.2% Nurse Midwife Nurse Practitioner NOTE: This question was added on the 2011 survey. 7 Data for are from the annual Michigan Center for Nursing Survey of Nurses. 8 All nurses are required to renew their license every two years after receiving their first license, which results in two approximately equal cohorts of nurses. Analysis of survey data prior to 2009 shows a difference between these two cohorts of nurses in age distribution. Therefore, survey responses prior to 2009 that may be affected by age such as plans to continue practicing nursing should be compared only to responses received from the same license renewal cohort (e.g., 2009 compared to 2007, 2008 compared to 2006). 9 Frequencies reported may not equal 100 percent due to rounding. 12 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

13 If you are practicing as an advanced practice registered nurse, do you have a Drug Enforcement Agency (DEA) number? Active APRNs Only 2013 a) Yes 7.3% b) No 92.7 If you are practicing as an advanced practice registered nurse, do you have a National Provider Identifier (NPI) number? Active APRNs Only 2013 a) Yes 14.2% b) No If you hold a specialty certification listed above, on average, how many hours per week do you provide direct patient care as an advanced practice nurse? RNs 2011 (n= 1,263) RNs 2012 (n=695) RNs 2013 (n=740) Less than 10 hours per week 4.7% 5.9% 5.3% hours per week hours per week hours per week More than 35 hours per week I am practicing as an APRN, but with no time in direct patient care I am not currently practicing as an APRN NOTE: This question was added on the 2011 survey. 13 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

14 4. What is your education background? (Mark all that apply.) a) LPN diploma/ certificate of nursing LPN certificate of achievement b) RN diploma in nursing c) Associate s degree in nursing d) Bachelor s degree in nursing e) Master s degree in nursing f) Master s degree in other field % 5.5% 5.8% 5.6% 4.6% 4.6% 4.7% 3.8% 3.6% % g) Doctorate in nursing h) Doctorate in other field i) Other degree NOTE: In 2004, 21.8% of all RNs reported they held a diploma in nursing. On the 2005 survey, Diploma in nursing was replaced as a response option by LPN diploma in nursing, LPN certificate of achievement, and RN diploma in nursing. On the 2006 and 2007 survey, LPN diploma in nursing and LPN certificate of achievement were combined as one response option. 5. If you have a doctorate in nursing, please indicate the type of doctorate degree. (Mark all that apply.) a) Doctor of Nursing (ND) 3.2% 2.7% 3.0% 2.2% 1.9% b) Doctor of Nursing Practice (DNP) c) Doctor of Nursing Science (DNSc) d) Doctor of Philosophy (PhD) Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

15 6. Are you currently enrolled in a program to obtain a Bachelor of Science in Nursing (BSN), Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or Doctor of Philosophy in Nursing (PhD)? (Mark all that apply.) a) Bachelor of Science in Nursing (BSN) 4.1% 4.0% 4.5% 5.5% 6.6% b) Master of Science in Nursing (MSN) c) Doctor of Nursing Practice (DNP) d) Doctor of Philosophy in Nursing (PhD) NOTE: This question was consolidated, and Doctor of Nursing Practice and Doctor of Philosophy in Nursing were added as choices in the 2011 survey. Data from previous surveys have been consolidated in the same way so the trend can be viewed. 7. If you are enrolled in a program to obtain an MSN, is the program designed to prepare you for specialty certification as a Nurse Practitioner? 2013 a) Yes 52.2% b) No What is your current employment status? (Mark one.) a) 35 or more hours per week in nursing or related area 62.3% 60.2% 61.6% 60.6% 60.8% 59.7% 59.3% 59.0% 60.2% 58.4% b) Less than 35 hours per week in nursing or related area c) Employed, but not in nursing d) Not employed, and seeking employment in nursing or related area e) Not employed, and seeking employment outside of nursing f) Temporarily not working and not looking for a job g) Retired or with no plans to return to work Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

16 9. Identify your current employment setting(s). (Mark all that apply.) a) Hospital inpatient 50.2% 57.7% 58.9% 57.5% 56.5% 56.5% 54.3% 55.5% 54.3% 53.2% b) Hospital outpatient c) Non-hospital outpatient d) Physician s office e) Federally qualified health center f) Retail clinic g) Nurse managed clinic h) Correctional system i) Nursing home/long-term care facility j) Home health care k) Hospice l) Public/community health m) Elementary or secondary school health n) College health center o) Nursing education p) Insurance company/health plan q) Traveling/staffing agency r) Other s) None (not active in nursing) NOTE: Nurses were asked to indicate all of their current employment settings, so the sum of the percentages will be more than 100 percent. Federally qualified health center, Correctional system, Nurse managed clinic, and Retail clinic were added as settings in the 2011 survey. Also in 2011, School health was separated into two setting options: Elementary or secondary school health and College health center. 10. Does your main nursing position involve providing direct care services to patients/families? Active only Yes 82.6% 85.1% 85.7% 84.5% 83.3% 83.1% 82.6% 82.9% 81.6% 81.4% No Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

17 11. If you provide direct care services, please identify your main practice area. (Mark one.) (Note: Response frequencies for 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 are for active nurses only.) Active only a b 2011 c a) Anesthesia 2.7% 2.6% 1.9% 1.8% b) Cardiology/cardiac care c) Case management 5.1% 7.7% 11.8% 3.8% 3.6% 6.3% d) Critical care e) Dialysis/hemodialysis f) Emergency/urgent care g) Endoscopy/diagnostic testing h) General/family practice i) Geriatrics/elderly care j) Hospice/palliative care k) Internal Medicine l) Medical-Surgical m) Neonatal n) Obstetrics o) Oncology p) Patient education q) Pediatrics r) Peri-operative s) Psychiatric/mental health t) Rehabilitation u) Surgery v) Women s health w) Other NOTES: a) Geriatrics/elderly care and Oncology were added as response options on the 2005 survey. b) Anesthesia, Cardiology/cardiac care, Endoscopy, Hospice, Neonatal, and Rehabilitation were added as response options on the 2010 survey. c) On the 2011 survey instrument, Med-Surg was changed to Medical-Surgical ; Surgery was dropped; Endoscopy was changed to Endoscopy/diagnostic testing ; General/Family Practice was changed to Family practice ; Internal medicine was added; Hospice was changed to Hospice/palliative care ; and Peri-operative and Women s health were added. In 2011, to adjust for a coding error, online responses were not included in the analysis for this question. 17 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

18 12. To assist us in projecting the supply of nurses in the future, please tell us how much longer you plan to practice nursing. Years a) % 14.8% 13.2% 16.8% 17.7% 17.9% 19.5% 19.5% 19.2% 21.0% b) c) d) e) f) More than g) Don t know If you made a change in your employment position within the past 3 years was it to (Mark all that apply.) a) Change from an inpatient position to an outpatient position? 5.2% b) Change from an outpatient position to an inpatient position? 1.7 c) Change from a primary care position (i.e., family practice, general medicine, internal medicine, 2.4 or general pediatrics) to a specialty care position? d) Change from a specialty care position to a primary care position? 1.0 e) Make some other employment change? In your current position, are you a member of an interdisciplinary patient care team? (An interdisciplinary team includes at least two different types of health providers who work collaboratively with patients and their caregivers to the extent preferred by each patient to accomplish shared goals within and across settings to achieve coordinated, high-quality care.) 2013 a) Yes 67.8% b) No Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

19 15. If you are a member of an interdisciplinary patient care team, does your role on the interdisciplinary team include participation in (Mark all that apply.) a) Discussion of team members roles and responsibilities? 56.5% b) Clinical discussions or huddles with the patient care team? 66.1 c) Patient rounds with other members of the patient care team? 41.6 d) Team meetings with patients and their families? 36.1 e) Development of shared goals reflective of patient priorities and supported by all team members? 59.9 f) Virtual communication with other team members through an electronic health record, , or 51.6 text messages? g) Evaluation of team processes and patient health outcomes? Where is your primary place of employment? (Mark one.) a) Michigan 89.4% 87.9% 89.8% 88.7% 89.7% 89.7% 90.4% 90.9% 91.6% b) Other state in the U.S. c) Canada d) Other nation If you live in the U.S. or if your primary place of employment is in the U.S., what are the Zip Codes of your residence and primary place of employment? 18. In what year were you born? (Note: Response frequencies are for active nurses only.) (N = 14,933 in 2013.) Average age = Age <25 1.4% 1.3% 1.6% 1.3% 1.7% 1.7% 1.5% 1.7% 3.2% 2.0% Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

20 One of the goals of the Michigan Center for Nursing is to increase diversity within the nursing profession. It would be helpful if you would answer the following questions: 19. What is your gender? a) Female 92.2% 93.2% 92.1% % 94.0% 93.9% 93.8% 93.5% 93.7% b) Male Are you Spanish/Hispanic/Latino? a) Yes 1.5% 1.3% 1.4% 1.3% 1.4% 1.4% 1.6% 1.4% b) No What is your racial/ethnic background? a) White 87.7% 86.9% 86.0% 87.4% 87.7% 87.0% 87.6% 87.1% 88.5% 87.8% b) Black or African American c) American Indian or Alaska Native d) Asian e) Native Hawaiian or Pacific Islander f) Middle Eastern (Arab, Chaldean, other) g) Multiracial h) Some other race/ethnicity Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

21 Questions removed from the survey in 2013: 22. Did you graduate from a nursing school in the United States or in another nation? a) United States 93.7% 92.8% 95.1% 93.4% 93.6% 93.7% 94.4% 94.4% 95.7% b) Other nation Have you voluntarily left a nursing position in the last two years? % of all licensed RNs a) No 78.3% 78.5% 79.2% 80.2% 82.1% 79.2% 74.9% % of RNs who left a position b) Yes, I took another nursing position in the same organization c) Yes, I took another nursing position with a different organization d) Yes, I took a position outside of nursing e) Yes, I retired/quit nursing NOTE: This question was consolidated in the 2011 Survey. Data from previous surveys have been consolidated in the same way so the trend can be viewed. 24. If you answered yes to the question above, what were the factors that led to this decision? (Mark all that apply.) % of RNs who left a position a) Age 12.6% 12.5% 13.9% 15.0% 16.0% 20.0% 27.2% b) Employer/employee conflict c) General lack of job satisfaction d) Inadequate salary/wages/benefits e) Increasing administrative burden f) New career opportunity g) Personal or family demands h) Physical demands of the job i) Relocation j) Opportunity to work in nursing administration k) Opportunity to work in nursing education Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

22 % of RNs who left a position l) Career promotion 12.7% 14.5% 14.5% 12.9% 13.0% m) Child bearing/child rearing NOTE: Nurses were asked to indicate all factors that led to their decision to leave a nursing position in the last two years, so the sum of the percentages will be more than 100 percent. In 2011, Personal or family concerns was changed to Personal or family demands ; Inadequate salary/wages and Inadequate benefits were combined into one option; Career promotion was changed to New career opportunity ; and Relocation was added as an option. Also in 2011, Childbearing/childrearing, Opportunity to work in nursing administration and Opportunity to work in nursing education were removed as options. 25. Where do you live? (Mark one.) a) Michigan 87.6% 88.6% 88.0% 89.0% 89.4% 89.9% 90.6% b) Other state c) Canada d) Other nation NOTE: As a result of a mailing error, the responses to this question were not valid for Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

23 Appendix B: Survey Instrument and LPN Response Frequencies ,11,12 For 2013 survey results, N=2,894 This information is being collected by the Michigan Center for Nursing to describe the supply of and demand for nurses in Michigan. Data from this survey will be used to inform state and local decision making regarding the recruitment, education, and employment of nurses in Michigan. The information you provide will be confidential; the identity of individual respondents will not be shared with anyone. Completion of the questions below is voluntary and does not affect your license. However, this information is important and your participation is encouraged and truly appreciated. Please complete the survey and return it with your renewal application in the envelope provided. If you are both an LPN and an RN, complete and return only one survey. If you renew your license via the Internet, you will have the opportunity to complete this survey online. Go to to view survey results and to sign up to receive Michigan Center for Nursing News & Updates electronically. 1. Are you a licensed practical nurse (LPN), a registered nurse (RN), or both? (Mark one. If you are both an LPN and an RN, complete and return only one survey.) Note: This question was used only to identify respondents as RNs or LPNs and to determine the proportion of RNs who also hold a diploma/certificate as a LPN. 2. Do you hold a Michigan specialty certification as a 1) Nurse Anesthetist, 2) Nurse Midwife, 3) Nurse Practitioner Note: This question is not applicable. If you are practicing as an advanced practice registered nurse, do you have a Drug Enforcement Agency (DEA) number? Note: This question is not applicable. If you are practicing as an advanced practice registered nurse, do you have a National Provider Identifier (NPI) number? Note: This question is not applicable. 3. If you hold a specialty certification listed above, on average, how many hours per week do you provide direct patient care as an advanced practice nurse? Note: This question is not applicable. 10 Data for are from the annual Michigan Center for Nursing Survey of Nurses. 11 All nurses are required to renew their license every two years after receiving their first license, which results in two approximately equal cohorts of nurses. Analysis of survey data prior to 2009 shows a difference between these two cohorts of nurses in age distribution. Therefore, survey responses prior to 2009 that may be affected by age such as plans to continue practicing nursing should be compared only to responses received from the same license renewal cohort (e.g., 2009 compared to 2007, 2008 compared to 2006). 12 Frequencies reported may not equal 100 percent due to rounding. 23 Michigan Center for Nursing Survey of Nurses 2013 Prepared by Public Sector Consultants Inc.

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